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Assistant Professor of Surgery, Harvard Medical School

Research Group

Research Focus

Over the past several decades there has been a substantial increase in the diagnosis and treatment of differentiated thyroid cancer. This rise has largely been attributed to increased detection of nonaggressive and nonlethal thyroid cancers. It has been suggested that this rise has resulted in an epidemic of overtreatment of thyroid cancer. My research has focused on population-level analysis of thyroid cancer incidence and the clinical and economic implications of this rapid rise.

Effect of healthcare expansion on the treatment of thyroid cancer

In 2006, the Commonwealth of Massachusetts passed a health care reform law which expanded health insurance for government-subsidized, self-pay, and uninsured individuals in the state. I hypothesized that as a result of healthcare expansion, there would be an increase in the rate of thyroidectomy for thyroid cancer related to increased access to care. To evaluate this hypothesis, we used data from the State Inpatient Databases (SID) for Massachusetts and six control states. Using difference-in-difference models, we were able to show a startling 26 percent increase in the treatment of thyroid cancer as a direct result of this healthcare reform. These results were published this year in JAMA Surgery (2017;152(8):734-740) and was widely cited in Medscape, Science Newsline, and Ecancer, among others.

Economic impact of a diagnosis of thyroid cancer

Cancer care expenditure in the United States continues to rise yearly and is projected to surpass $150 billion by 2020. Although thyroid cancer has a generally high survival rate, it is associated with a potential long term financial and psychological impact, which has not previously been rigorously studied. We aimed to evaluate the comparative prevalence of financial and psychological hardship among U.S. thyroid cancer and non-thyroid cancer survivors. In an ongoing evaluation using the Agency for Healthcare Research and Quality Medical Expenditure Panel Survey (MEPS), we have found that thyroid cancer survivors experience a significantly higher level of both material and psychological financial hardship compared to non-thyroid cancer survivors. These findings suggest that financial hardship may be under-recognized in the medical community and warrants further investigation into the etiology behind the financial burden associated with a diagnosis of thyroid cancer.

Treatment patterns in thyroid cancer

Over the past 15 years, there has been a growing body of literature suggesting a rising incidence of thyroid cancer without a rise in mortality. As a result, there has been a shift in guidelines to offer less aggressive surgical intervention. These recommendations have come as multiple studies have shown that patients with thyroid cancer may have a similar prognosis when undergoing less aggressive surgical intervention such thyroid lobectomy. Our group hypothesized that despite evidence of equivalent survival with less aggressive treatment, patients are still undergoing aggressive surgeries for the treatment of thyroid cancer regardless of the size of the cancer. We are currently evaluating these treatment patterns and have shown in preliminary research that the trends in treatment patterns over the past 15 years, have not changed.

Accomplishments 2016-2017

Elected to the Editorial Board of the Journal of Surgical Research

Elected to the Program Committee for the Academic Surgical Congress

Appointed Associate Surgery Clerkship Director, BIDMC

Invited Presentations

An update in international trends in incidence rates of thyroid cancer from 1973-2007, Academic Surgical Congress

An estimate of economic and psychological hardship among thyroid cancer survivors, American College of Surgeons

25 years of therapy for papillary thyroid cancer, American Thyroid Association

Teaching, Training, and Education

I have developed an endocrine surgery teaching series for residents rotating on the endocrine surgery service. This series has been developed to prepare residents for both the written and oral general surgery boards. As a result of my dedication to education, I was given a teaching award in 2016. I have also taken on a teaching role in the Department of Surgery at BIDMC as the associate clerkship director for Harvard Medical School students.

Selected Publications

Applewhite MK, James BC, Aschebrook-Kilfoy B, Kaplan EL, Angelos P, Grogan RH. Quality of life in thyroid cancer is similar to that of other cancers with worse survival. World Journal of Surgery 2016;40(3):551-61.